Individual
MS. ANN MARIE GUSTAFSON-LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CNP
Contact information
Practice address
1900 CENTRA CARE CIRCLE #2500, CENTRA CARE CLINIC HEALTH PLAZA / ENDOCRINOLOGY, ST CLOUD, MN 56303-5000
(320) 229-5000
Mailing address
1900 CENTRA CARE CIRCLE #2500, CENTRA CARE CLINIC HEALTH PLAZA / ENDOCRINOLOGY, ST CLOUD, MN 56303-5000
(320) 229-5000
(763) 689-7878
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
1134
MN
363LA2200X
Adult Health Nurse Practitioner
Primary
R-103319-9
MN
Other
Enumeration date
03/28/2007
Last updated
09/11/2012
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